This entry is our analysis of a study considered particularly relevant to improving outcomes from drug or alcohol interventions in the UK. The original study was not published by Findings; click Title to order a copy. Free reprints may be available from the authors – click prepared e-mail. Links to other documents. Hover over for notes. Click to highlight passage referred to. Unfold extra text The Summary conveys the findings and views expressed in the study. Below is a commentary from Drug and Alcohol Findings.

Hornik R., Jacobsohn L., Orwin R. et al.American Journal of Public Health: 2008, 98(12), p. 2229-2236.Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr Hornik at rhornik@asc.upenn.edu. You could also try this alternative source.

Could the US government's biggest ever attempt to use the media to turn US youth away from cannabis actually have done the reverse? At best it was a disappointment; at worst, it counterproductively fostered the impression that 'Everyone's doing it'.

Funded by nearly $1 billion appropriated by the US Congress, the campaign aimed to educate and enable America's young to reject illegal drugs, to prevent initiation of drug use (especially cannabis and solvents), and to persuade occasional drug users to stop. Youth-focused communications mainly broadcast through television and radio ads (but also through posters and cards illustrations) aimed to achieve these objectives by bolstering young people's resistance skills and confidence in their abilities to reject drug use, correcting mistaken assumptions about how 'normal' or accepted drug use was among their peers, promoting positive drug-free alternatives, addressing the benefits of not using drugs, and highlighting the negative consequences of drug use, including effects on academic and athletic performance. Main features of the study's methodology are described below.

The researchers concluded that while the campaign had successfully reached the children it targeted, there was no evidence that this exposure had the intended impacts on their cannabis uptake, and it may have promoted more pro-cannabis attitudes and beliefs.

After the period reported on in the featured study, the campaign again
changed tack, adopting the label Above the Influence to signify the incorporation of messages encouraging children to avoid or resist peer influences which promote substance use. The campaign's own monitoring suggests this has avoided its predecessor's counterproductive impact on social norms related to cannabis use. But at the time of writing this latest revision of the campaign had yet to be subjected to the kind of independent evaluation which was unable to support the earlier versions.

However, it remains possible that the earlier campaigns really did have the intended impacts, but these were not picked up by the featured study. Details in background notes. In summary, there seems little to support arguments that the ads stuck in the mind of children most likely to use cannabis, creating the illusion that seeing the ads caused pro-cannabis effects. From the study's broader findings, it also seems unlikely that there were counterbalancing positive impacts on the more high-risk children or (these were excluded from the featured report) children who had already tried the drug. Two studies (details in background notes) in the same two medium-sized cities, either of the campaign itself, or of anti-cannabis ads specially developed to target high sensation-seeking teenagers, suggested that such teenagers may respond as intended, even if their less sensation-hungry peers are unmoved. Due partly to methodological problems and to the limited nature of the samples, these are not a persuasive counter to findings from the national study. What cannot however be excluded is the possibility that the outcomes in that study might have been partly due to differences between children who recalled lots and those who recalled few ads, rather than purely due to their exposure to the ads.

The most far-reaching argument, advanced by the study authors themselves, and for which there was some evidence, is that no matter what deterrent impact the campaign's explicit messages may have had, these were (possibly more than) counterbalanced by an implicit message that drug use was hard to resist and common among children of the same age as the viewer or listener, a sometimes powerful influence promoting substance use. Why else, the young viewers might subliminally have reasoned, would the government be so keen to warn us about drugs and think we need help to resist?

The featured study had to rely on 'messy' real-world data. Others have been able to exercise greater control in examining how children react to the same or similar ads. They too support the simple explanation that the campaign seemed ineffective because it was, and also show how it might have been counterproductive. In one study nearly half the tested ads were seen as less effective in deterring youth substance (in particular, cannabis) use than simply watching a neutral TV programme. An offshoot of this study found that watching ads which graphically portrayed the 'gateway' message ('soft' drug leads to 'hard' drug use and addiction) left children feeling more positive about cannabis and more likely to use the drug, it seems because those most likely to use tended to "move towards disbelieving that regular marijuana use has negative consequences".

These studies suggest that among young people most likely to use cannabis, focusing on harmful consequences was a difficult strategy to carry off with any credibility in respect of a drug where clear-cut examples are hard to find. Apart from the unintended 'Everyone's doing it' message, some other features may also have undermined the campaign's effectiveness. A major theme implied that the choice young people faced was between cannabis use and other valued activities and identities, yet the experience of many will have been that usually no such dilemma presents itself. In turn this theme rested on the theme that cannabis use detrimentally dominates young lives, a depiction which all but a few could deflect as 'nothing like them' or their friends. Finally, there were explicit urges to independence of mind ("We need to stand up for ourselves and become independent thinkers"); if taken to heart, these might as easily have led to rejection of the government-sponsored messages as their acceptance.

Thanks for their comments on this entry in draft to Robert Hornik of the University of Pennsylvania. Commentators bear no responsibility for the text including the interpretations and any remaining errors.